Leaked: LGBTQ Groups' Memo On Combatting Trump's Attack On Pediatric Gender Medicine
The secret memo, which is meant to help backers of pediatric gender medicine fight for the field in the court of public opinion, discourages focusing on the quality of the related scientific evidence.
I reported today in The New York Sun about the Trump Justice Department’s decision not to withdraw the complaint, submitted last year by the Biden administration, to the Supreme Court over Tennessee’s ban on pediatric gender-transition treatment. Whether the Trump administration would stay the course despite inevitably switching sides to back Tennessee had hung over the case since President Donald Trump’s victory in November.
The decision in the landmark case is expected in June. Legal observers generally believe that Tennessee will prevail and the court will uphold the state’s ban.
In my new article for the Sun, I also reported about a document I obtained that contains talking points written by LGBTQ advocacy groups. The memo is meant to help supporters of pediatric gender medicine fight in the court of public opinion on behalf of this field in the face of President Donald Trump’s all-out assault. This Substack serves as an appendix to my article and includes the full contents of the memo.
The memo encourages advocates of pediatric gender medicine to focus on arguments that characterize the Trump administration as overstepping its legal authority and to avoid discussions of the quality of the scientific evidence in this field. This suggests that the memo’s authors see questions about the strengths of the relevant research as a crucial weakness in their overall public relations strategy to aid this besieged—and, some might argue, out-right doomed—medical field.
Naomi Goldberg, executive director of the Movement Advancement Project (MAP), distributed the memo at least in part through an LGBTQ-related listserv on Jan. 29, the day after Mr. Trump issued his executive order, or EO, seeking to use the power of the purse to block access to gender-transition treatments and surgeries by youth under age 19.
In the email, which I obtained, Ms. Goldberg said that the “messaging guide,” included as a PDF attachment, had been developed by GLAD Law, MAP, the National Center for Lesbian Rights (NCLR) and the Whitman-Walker Institute. The memo, she wrote, provided “recommendations for talking about” the executive order.
Below is a gallery with the full copy of the memo, which spans a little over two pages in its original PDF form.
The top-line message in the memo is that supporters of pediatric gender-transition treatment should emphasize that this is indeed “medically necessary care” and that the Trump administration is guilty of “extreme government overreach” by subverting the private decisions of caregivers in his effort to ban access among youths.
“Parents and families, not the government, know what is best for their children,” the memo states.
This is essentially a due-process argument, one that the ACLU made during the initial rounds of the U.S. v. Skrmetti case over Tennessee’s ban that took the suit through the 6th District Court of Appeals, which upheld the law. However, while the ACLU filed a complaint with the Supreme Court asserting that the Tennessee law violated the plaintiff's’ due-process and equal-protection rights, the Supreme Court only agreed to hear the Biden administration’s complaint. That complaint focused just on the equal-protection claim, arguing that the ban violates the 14th amendment by discriminating based on sex.
The memo is adamant that prescribing puberty blockers and cross-sex hormones to minors is based on “well-established standards of care.”
This claim is in conflict with the findings of a trove of internal communications—they were subpoenaed by the Alabama attorney general, Steve Marshall—among leaders at the World Professional Association for Transgender Health (WPATH) as they developed their 2022 revision to their widely-referenced trans-care guidelines. As Mr. Marshall wrote in his scathing amicus brief to the Supreme Court in the Skrmetti case, WPATH leaders were aware that the evidence base for their chapter on adolescent care was weak. Absent scientific evidence to back such an assertion, WPATH included the words “medically necessary” throughout the guidelines, for the purpose of securing insurance coverage and improving their chances in litigation.
Asserting that Mr. Trump’s executive order is “filled with disinformation and deception” (which is absolutely true), the talking-points memo calls gender-transition treatment for minors “proven care” that is backed by all leading U.S. medical associations.
Such treatment is not, however, proven according to the numerous systematic literature reviews—the gold standard of scientific evidence—that have been published over the past five years regarding the research backing pediatric gender medicine. As I reported in the Sun last month, a team led by the “godfather of evidence-based medicine,” Dr. Gordon Guyatt of McMaster University in Canada, found in its systematic review and meta-analysis that there is:
“considerable uncertainty regarding the effects” of each intervention [in pediatric gender-transition treatment], given that the available research almost entirely yielded evidence of “very low certainty.” Regarding hormone treatment in particular, the authors concluded that “we cannot exclude the possibility of benefit or harm.”
Additionally, it has been public, if not necessarily common, knowledge since August that the American Society of Plastic Surgeons has not endorsed pediatric gender-transition treatment or surgeries, as I reported on Sept. 6:
The talking-points memo then engages in a sleight of hand, citing polling that says that 82% of voters “believe that politicians should let parents and doctors make healthcare decisions for young people who are transgender.” What the document neglects to mention is that the vast majority of Americans, including most Democrats, believe that minors should not be able to access puberty blockers or cross-sex hormones for transgender care, according to a recent New York Times poll.
Then there is this passage in the talking-points memo:
The evidence around the safety and effectiveness of healthcare for transgender people of all ages is as strong as the evidence for treatments across other areas of medicine. There’s been decades of substantial peer-reviewed research showing that this care is safe, effective, and essential to the health and well-being of transgender young people.
As I reported in The Sun:
Moti Gorin is a bioethicist and a professor of philosophy Colorado State university who is a skeptic of pediatric gender-transition treatment. In an interview, he said that based on the currently available evidence, he believes these interventions represent an unfavorable balance of risk versus benefits. He criticized as vague and overly broad the talking-point list’s effort to compare such treatments across other medical disciplines.
Dr. Gorin said that to make a fair comparison across pediatrics in particular would demand “comparable cases with similar risk-benefit profiles, where the interventions were nevertheless routinely administered.”
In addition to causing irreversible physical changes, prescribing cross-sex hormones to minors can pose a risk of infertility and sexual dysfunction, especially among natal males who begin taking puberty blockers early in adolescence.
Instead of focusing on the quality of the evidence in this field, advocates of pediatric gender medicine often tout to the length of time that has passed since the field was founded—decades.
This is a misleading characterization on the advocates’ part. Indeed, Dutch researchers first began prescribing blockers and hormones to a small cohort minors with gender dysphoria in the mid-1990s. But this did not begin to inspire the contemporary gender-clinic movement across the Western world until the late 2000s to early 2010s. And even then, gender dysphoria remained quite rare among adolescents until around 2011 to 2015, at which point the number of youths presenting at these clinics began to surge. (This was around the time that smartphone and social-media app use became ubiquitous among adolescents, which itself coincided with a sharp decline in youth mental health.)
So in fact, this is a medical field that while dating back 30 years, was quite tiny until about a decade ago. And there remains very little long-term follow-up in cohort studies of people who have been prescribed blockers and hormones as minors.
The talking-points memo discourages advocates of such treatments from getting into the weeds in discussing scientific research, characterizing this as a trap into which those working in bad faith will set for them to fall.
The memo states:
If detailed questions arise about the executive order’s attacks on care for transgender youth, the following messages can be helpful. However, note that these messages can also open the door to disingenuous “questions” about the evidence backing the care. Be sure you pivot back to the Core Messages (see page 1) to make it more difficult for opponents to try and derail the conversation.
The document then claims that minors who receive gender-transition treatment only do so after receiving “extensive evaluation” by a multidisciplinary team, which, the memo says, takes place over a significant period of time.
While a rigorous patient-evaluation process might be the standard that WPATH has set for clinics to follow in its trans-care guidelines, there is considerable evidence that multiple clinics either never follow this standard, or at least sometimes do not.
As I wrote in the Sun:
As the Sun previously reported, since 2018, it has been the policy of Boston Children’s Hospital only to provide children and their parents a single, two-hour assessment appointment with a psychologist before deciding whether to refer the child to endocrinology for puberty blockers or hormones.
A 2022 Reuters investigation identified seven pediatric gender clinics that said they would prescribe such drugs to minors on the first appointment if they saw no “red flags.”
And in December, Dr. Johanna Olson-Kennedy, one of the top pediatric gender doctors in the nation and a lead investigator on a $10 million National Institutes of Health grant to research these interventions, was sued by a former patient to whom she allegedly prescribed puberty blockers on the first appointment without providing the patient, who was 12 years old, with a psychosocial evaluation, as advised by WPATH’s trans-care guidelines.
Dr. Olson-Kennedy is the president of WPATH’s U.S. branch, USPATH. But she has spoken out against the WPATH guidelines’ demand for conducting detailed assessments before putting children on gender-transition drugs. So has Dr. Jack Turban, a child and adolescent psychiatrist at the University of California, San Francisco and vocal advocate of pediatric gender medicine.
In closing, the memo states: “Don’t take opponents’ bait around the research studies they’re attacking. Instead, focus on government overreach.”
I write in the Sun:
Kellan Baker, executive director of The Institute for Health Research & Policy at the Whitman-Walker Institute, is listed as the primary contact on the document. He and Ms. Goldberg did not return a request for comment.
Dr. Baker was a member of the team at the World Professional Association for Transgender Health, the influential U.S.-based activist-medical organization that commissioned a lengthy roster of systematic reviews about transgender care from evidence-based medicine experts at Johns Hopkins University. According to internal WPATH communications that were subpoenaed in the federal case over Alabama’s ban of gender-transition treatment for minors, WPATH suppressed many of these reviews when the findings were not to their liking. They ultimately only permitted the publication of two of them.
Dr. Baker was the lead author on one of those reviews. It looked at studies of treatment with cross-sex hormone treatment among both adolescents and adults and found it was associated with various psychological benefits. But similar to all other such reviews about pediatric gender medicine in particular, the review found that the certainty of such conclusions was “limited by high risk of bias in study designs, small sample sizes and confounding with other interventions.”
The apparent lead author of the talking-points memo, however, is Sean Lund, managing director of messaging research programs at MAP. This is according to the meta data on the PDF of the memo.
Mr. Lund is also the apparent lead author of this document: “TALKING ABOUT Curriculum Censorship: Transgender Youth Participation in Sports, Medical Care Bans: Public Education Messaging Overview.” It is a comprehensive primer on how to combat efforts to: censor LGBTQ-related subjects and materials in schools, restrict youth sports by biological sex, and ban gender-transition treatment for minors.
A companion document from MAP focusing just on the medical interventions provides similar guidelines to the new talking-points memo, some of it word for word:
Note that the MAP document’s claim, that rate of detransitioning among those who have undergone cross-sex hormone treatment as a minors is “extremely rare,” is not supported by evidence. The truth is that the detransitioning rate remains unknown due to limited loss to follow-up in the available cohort studies, as the Cass Review indicated.
It is worth noting that the MAP document, like the new memo, explicitly discourages any discussion of the science in this field—and then offers an unscientific claim as a means of deflection in the event that a discussion does turn down that path.
I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC News and The New York Sun. I have also written for theWashington Post, The Atlantic and The Nation. Follow me on Twitter: @benryanwriter and Bluesky: @benryanwriter.bsky.social. Visit my website: benryan.net
Thanks for your reporting, Ben.
Looks like the memo is being put to use:
https://x.com/glennagoldis/status/1887953947157041514